For more than a decade the U.S. Surgeon General has not issued a new advisory. That changed last month when Dr. Jerome Adams, formerly Indiana’s state health commissioner, recommended that more Americans carry medication to reverse an opioid overdose.

While in Indiana and many other states the drug naloxone is now available without a prescription in many pharmacies, it can cost anywhere from $30 to more than $100 for one usage.

However, the Indiana State Department of Health has made free naloxone kits available to those willing to undergo an hour-long free training session through local health departments.

Since August 2016 when the program funded by state and federal monies began, 49 county health departments have received 13,721 naloxone kits, costing a total of $579,500. Ten additional counties have recently joined the program, state health officials said.

As of December, Marion County had distributed the most kits of any of the counties, 1,400, according to Indiana University researchers who are collecting data on the program. Scott County followed with 1,245 kits and then Delaware County with 800.

Marion County health officials have done more than 200 training sessions since the program began, said Byron Reynolds, program manager for substance use outreach services for the Marion County Health Department. They have handed out more than 1,500 kits at churches, community centers, motels, liquor stores and truck stops. The biggest session, for homeless outreach workers held on the east side drew 65 people.

In addition to the naloxone kits the county health department receives from the state, local health officials now will have an additional 900 kits each year to hand out from a federal grant, Reynolds said.

Many of those who have attended the sessions are parents of children who are using drugs, said Debra Buckner, administrator of substance use outreach services for the Marion County Health Department.

“Some of the parents have experienced a child suffering an overdose. They’re very concerned and come to the training to get a kit,” she said.

Anywhere from 15 to 60 people show up at the Narcan giveaway events that the Hamilton County Health Department has had in the past year, said James Ginder, a health educator with the department.

Each month Ginder hosts two to three events, often at the invitation of community groups. One event last year in Sheridan drew about 60 people. The next event will be this Wednesday at the department's Noblesville offices.

“A lot of people come to these events because they have family members in rehab or they’re just concerned citizens,” Ginder said. “It’s really important that people understand that … even though Hamilton County is the healthiest county in the state, we have health problems just like anybody else.”

Each kit contains two postcards, one to be mailed to IU researchers before the naloxone is used and one to be sent after it has been used.

The postcards will also help the researchers evaluate how often those who intervene in an overdose contact 911 emergency workers. Although Indiana has a Good Samaritan law that gives people immunity if they call in an overdose, some may fear repercussions if they summon help.

Between 20 to 25 percent of those who have sent back the cards after using the naloxone kits report that they did not call 911 because of their fear of police, said Dennis Watson, an associate professor of social and behaviorial sciences at the Indiana University Richard M. Fairbanks School of Public Health.

“Even if people are aware of the law, they still don’t completely trust that they’re protected, which is fair because the law is written in a very confusing way,” Watson said.

Local health officials try to encourage people to call 911 at the training, telling them that they must call emergency services if they’re planning to use their kit and want a new one, Reynolds said. The kits recommend that the user first administer the drug and then call 911, even if they think the person will recover fully.

Stronger drugs on the streets these days such as fentanyl mean that more people who overdose may require multiple doses of naloxone to revive them. And emergency responders not only help save lives but may also transfer the person to a hospital, where he or she may be connected to recovery resources.

One family came to a Marion County training and got three kits — one for the son who used drugs and one for each of his parents. The son overdosed three times and each time the family brought him back but did not call 911, Reynolds said.

“That defeats the purpose of giving the kits out, because we want to give them some assistance,” he said.

As of February, more than 2,330 people returned the cards upon receiving the kit. According to the information found on the cards, more than a third of those who responded had seen at least one overdose; many had seen more.

More than 100 people returned the cards after using a kit. Nearly 70 percent of those had had the kit less than a month before using it. One person who used the kit wrote "thank you" on the back of the response card, Watson said. The positive response has surprised him.

“We really expected we would get five cards back … over the course of the whole study,” Watson said. “The reason we’re seeing a bigger response than we anticipated is that people are really thankful to have these kits.”

Call IndyStar staff reporter Shari Rudavsky at (317) 444-6354. Follow her on Facebook and on Twitter.